1. Pediatric Small Bowel Obstruction: Can we learn from adults? Phillip A. Bilderback, MD Surgery Resident Virginia Mason Medical Center Seattle, WA

4. 2100 patients who underwent laparotomy at a single institution 2.8% developed post-op bowel obstruction (median f/u 3.2 years) 70.5% required operative intervention 2x as common in patients younger than 1 year (28/601, 4.7%) as in older children (33/1586, 2.1%; P =.01) Not influenced by initial diagnosis and indication for laparotomy (P =.26) 2/3 children <1 yr presented w/in 1 yr, 75% w/in 2 yrs 80% older children presented w/in 1 yr

5. Population-based study: 1581 children <16 yo from administrative database Followed for 4 years Kids <5 yo: 4.2% had adhesion-related readmission Kids <16 yo: 1.1% has adhesion-related readmission 55% of all readmissions occurred in the first year.

6. CT Scan in adults

8. 2,089 pts admitted with SBO from KID database 1,786 (85.5%) underwent operative intervention with LOA (83.6%) or bowel resection (16.4%) Factors associated with the use of operative intervention were younger age, race, and management at a children’s hospital. The time from admission until operation was significantly longer in patients who underwent bowel rsxn (2.1 days) compared with LOA (1.5 days).

9. Retrospective study of an administrative database 165 admissions, 32 (19%) were managed with immediate op, 133 were initially managed nonop 107 (84%) went on to laparotomy 16% were managed successfully nonop. Delayed surgery or conservative management did not cause an increase in complications

10. Prospective inclusion of pts w/ uncomplicated SBO Unimproved after 48 hrs conservative Rx 8 pts matched to 16 controls on number of previous SBOs 50-100 mL gastrografin administered If constrast in cecum in 4-6 hrs started feeding and discharged

12. References Aguayo, Pablo, et al. "Laparoscopic management of small bowel obstruction in children." Journal of Laparoendoscopic & Advanced Surgical Techniques 21.1 (2011): 85-88. Becmeur, F., and R. Besson. "Treatment of small-bowel obstruction by laparoscopy in children multicentric study. GECI. Groupe d'Etude en Coeliochirurgie Infantile." European journal of pediatric surgery: official journal of Austrian Association of Pediatric Surgery...[et al]= Zeitschrift fur Kinderchirurgie 8.6 (1998): 343. Bonnard, A., et al. "Gastrografin for uncomplicated adhesive small bowel obstruction in children." Pediatric surgery international 27.12 (2011): 1277-1281. Eeson, Gareth A., Paul Wales, and James J. Murphy. "Adhesive small bowel obstruction in children: should we still operate?." Journal of pediatric surgery 45.5 (2010): 969-974. Feigin, Elad, et al. "The 16 golden hours for conservative treatment in children with postoperative small bowel obstruction." Journal of pediatric surgery 45.5 (2010): 966-968. Festen, C. "Postoperative small bowel obstruction in infants and children." Annals of Surgery 196.5 (1982): 580. Grant, Hugh W., et al. "Population-based analysis of the risk of adhesion-related readmissions after abdominal surgery in children." Journal of pediatric surgery 41.8 (2006): 1453-1456. Lautz, Timothy B., et al. "Adhesive Small Bowel Obstruction in Children and Adolescents: Operative Utilization and Factors Associated with Bowel Loss." Journal of the American College of Surgeons 212.5 (2011): 855-861. Lee, Justin, David B. Tashjian, and Kevin P. Moriarty. "Surgical Management of Pediatric Adhesive Bowel Obstruction." Journal of Laparoendoscopic & Advanced Surgical Techniques (2012). Wang, Qiuyan, et al. "Utility of CT in the diagnosis and management of small-bowel obstruction in children." Pediatric radiology (2012): 1-8. Young, Janet Y., et al. "High incidence of postoperative bowel obstruction in newborns and infants." Journal of pediatric surgery 42.6 (2007): 962-965.